Christy Duan: The prognosis for future doctors is not good

Dec. 16, 2013

Christy Duan

Written by

Christy Duan

Detroit Free Press guest writer

Growing up in Michigan, most of my family worked in the ailing auto industry, so I was no stranger to the word “unemployment.” As a future doctor, I never knew that word could easily apply to me.

When I started medical school in 2012, I thought that the prospect of medical students being unable to become practicing physicians was inconceivable, even absurd. But soon, despite the nation’s physician shortage of more than 16,000, it’s possible that MD students will be graduating with four years of intensive schooling, an average debt of $169,901 — and no job.

President Barack Obama’s proposed budget would cut $11 billion from Graduate Medical Education (GME) funding in the next 10 years.

GME, or residency, is clinical training that is mandatory for medical school graduates to obtain a license to practice medicine. Residents work under the supervision of fully licensed physicians for three to seven years, depending on their specialty. During this time, residents provide direct care for one out of every five hospitalized patients, including seniors, veterans, and the underserved.

These proposed cuts could force teaching hospitals to lay off as many as 73,000 staff members, reduce clinical research support, shut down training programs for health professionals, and eliminate services that are unavailable elsewhere in the community, according to the Association of American Medical Colleges. Although there is a pressing need to reduce the federal budget deficit, this short-sighted solution will hinder our healthcare system.

Under the president’s health reform plan, the demand for physician services will increase significantly. The United States is projected to face a shortage of 62,900 physicians across all specialties in 2015. That number is expected to double, to 130,600, by 2025. But health care coverage is useless if there are no physicians to treat patients, or if long waiting lists leave patients unable to access care.

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Even with new medical schools and increasing class sizes in existing schools, the number of practicing physicians is limited by funding for residency programs. In fact, the number of residency slots funded by Medicare has been capped since the 1997 Balanced Budget Act. President Obama’s proposed cuts will only exacerbate the physician shortage.

Many residents train at teaching hospitals, which provide care for 28% of all Medicaid hospitalizations. As of 2010, 23% of the population in Michigan was enrolled in Medicaid. While teaching hospitals make up only 6% of hospitals in the nation, they provide 40% of all charity care at a cost of $8.4 billion a year.

Although the $11 billion in cuts have not been made yet, we’re already seeing the effects of inadequate GME funding. This year, there were 1,958 more applicants competing for residency slots than in 2012. By 2015, there might not be enough residency slots for U.S. medical school graduates.

Three percent of U.S. medical school seniors did not obtain a residency slot in 2013. If that rate holds up, six out of the 183 students in my class may not have residency positions despite being some of the most intelligent, compassionate, hardworking and qualified people I know.

If we don’t save GME, it might be easier to see a doctor in the unemployment line than in hospitals and clinics.